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Background In a White Paper published in 2019, SHEA describes “The role of electronic health record and ‘add-on’ clinical decision support systems to enhance antimicrobial stewardship programs.” Modifications of the electronic health record and add-on clinical decision support systems are compared and contrasted. Some disadvantages of modification of the EHR include the need to include all end-user affiliates in modifications, lack of order set utilization, and heavy demands of IT staff to modify the EHR. We have utilized alternative alerts which may be customized to individual affiliates and are relatively easy to build which fire when specific medications are ordered (whether within order sets or not) and guide clinicians to more appropriate antibiotic choices. Methods From an antimicrobial stewardship perspective, alternative alerts are activated during the ordering of antibiotics for which routine use is discouraged (e.g., carbapenems, fluoroquinolones). When a provider enters an order, the alternative alert will pop up. The alert consists of two sections: an alert section describing the reason for the alert and a list of therapeutic options for the targeted drug; and links to orders for alternative antibiotics/combinations. The alerts may be configured to allow or not allow the orderer to continue with the original order. Different alternative alerts can be created and used at different facilities using the same EHR platform. We designed alternative alerts for fluoroquinolones, carbapenems, and fifth-generation cephalosporins that allowed providers to continue with the original order. We tested their impact on antimicrobial prescribing for 18 months after implementation, measured as quarterly days of therapy (DOT)/1000 pt-days. Results We noted marked reductions in quarterly DOT/1000 pt-days for fluoroquinolones (-70%) and fifth-generation cephalosporins (-90%). The impact on carbapenem prescribing was more variable. Conclusion Alternative alerts represent an easily created, customizable means to guide providers’ antimicrobial selections. We plan to incorporate more alternative alerts into our antimicrobial ordering process and strengthen the alert for carbapenems. Disclosures All authors: No reported disclosures.

1049. Using Alternative Alerts in the Electronic Health Record to Guide Antimicrobial Selection Decisionmaking at the Point of Order Entry